Have you ever wondered about the perfect crime?
Well they do exist. And the villains don’t usually appear with tall hats and twirling their moustaches. More often, they appear clean-shaven, wearing a white coat and a stethoscope, as well as a winning smile and the most articulate way of explaining things. Indeed, I might be one of those villains myself - at least I think I have a winning smile!
So these people, you know who they are, they’re called ‘doctors’, have these pieces of paper in frames, called a ‘medical degree’ and a ‘state medical license’, which is pretty much their way of telling the world: “you will not challenge what I say to you”. Fortunately, the vast majority of my patients (in fact probably ALL my patients) are smart and intelligent people. They always [quite appropriately] question my decision to order a particular test, such as a blood test, an x-ray, ultrasound, MRI, CT scan or specialty referral. When I say they ‘question’ it, I really mean, they ask me questions about it, such as “why do I need this?” and “what will it show?” and “is there something else that we could be doing instead?” and “can it wait?”, and stuff like that. You know, intelligent, reasoned questions that the good discerning patient would pose.
Now picture if you will, that same smart patient having pain or vomiting or trouble breathing, meaning the patient is now what is known as ‘acutely ill’. The threshold for getting a test automatically gets lowered, and it’s more of a “can we just get it done already?!” approach instead. To some people, this could be seen as a perfect opportunity for some good old-fashioned coercion...
Allow me to introduce you a physician who actually owns a testing machine and therefore makes money on it every time it’s used. Houston, we may have a problem…..
A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. If the secondary interest is the clear profit being made by ordering, I dunno, a CT scan for example, then the ‘acutely ill’ patient is now ripe for being run through the mill, whether that ‘mill’ is needed or not, and several things happen next:
So to summarize, if you want to make a lot of money and you have a medical degree and you don’t really care too much about someone getting lymphoma or breast cancer 20 years from now, just open a facility that has zero regulation and requires no licensing, and where acutely ill patients will go, and then you can easily use your documentation skills to justify ordering a CT scan on most of them (at least the ones with good insurance plans) and bam: you’re rolling in it! Just make sure your clinics are really pretty and nice. Make sure the place is well-lit, and you have start of the art exam rooms. Make sure you have the appearance of a spa, but with all the medical personnel and the best customer service. You know, all those retail mantras that’ll make people love you! Any decent criminal mind knows all this and will exploit the innocence of the general public and CT scan everyone for all their worth. I mean, if they’ve got a pulse, just scan them and you’ve got more than a medical license: you’ve got a license to print money with that CT scanner of yours. And to get all your doctors on board, make sure you train them on how to document things ‘properly’, just to get the scan past the insurance company, especially as you own the scanner. It wouldn’t hurt to give all your doctors a share of the profits from all the scans they order, and throw in some excellent benefits for good measure. What a brilliant business model. And everyone in the community will love you, without realizing what you’re really doing. Amazing: fame, fortune and accolades - what’s not to love?
Now that LICENSE to practice Medicine, is also a LICENSE to Print Money, and it's also a LICENSE to Kill people, albeit slowly. It'll take years for that malignancy to present, by which time the physician is probably retired or dead, and other parasites have taken his place.
But surely, no self-respecting doctor would do this. Would they? I mean, who’s ever heard of doctors committing crimes like that? Nah - perish the thought!
All around the country, this scam is going on. What do we call these ‘acute care clinic traps’? They’re called ‘urgent cares’.
As an aside, here’s a simple example of the ‘staged documentation’ that such CT-scamming physicians are doing:
So you just flew in from Chicago, not Beijing - "long flight". You smoked 2 cigarettes in college - "history of smoking". You're a 38 year old woman on birth control - "increased risk of blood clot". You've got pain in your chest when you breathe - ignore that it's only been going on for a couple of hours. Aha: CT chest to rule out a pulmonary embolism! And the insurance company's case manager falls for it because the documentation (see above) is so compelling. They don't have time to dig deeper. Approved by insurance! Cha-ching!
The market plays right into the physician’s greedy hands when the big insurance companies suddenly announce that they’re advising all their members to go to urgent care for CT scans, rather than to hospitals. It makes sense for the insurer: even the CT-scamming small-fry physician is costing them less than the hospital CT scan. So the insurer is now actively and knowingly enabling the perfect crime.
Therefore, the only people who can stop this are YOU the patients, or rather, the potential patient, assuming you’re not sick right at this minute. You probably wouldn’t be reading this if you were. But anyway, what can you do to prevent getting unnecessarily CT-scanned, or rather ‘CT-scammed’?
There are actually some simple things you can do.
Another thing you can try is to say you’re in a rush and can you do the scan another day - if they release you (unlikely) then call back and say you’d rather have it done somewhere else, such as at the hospital or one of the many independent imaging centers in your town.
It should be stated here that the vast majority of physicians are not villains. They practice good medicine and they follow evidence-based guidelines and when done correctly, order a CT scan is both perfectly appropriate and often life-saving. This article is not about those doctors - it's about the tiny minority of physicians who own a scanner and use it frivolously, without a care for the guidelines or published recommendations with regard to when to, and when not to, order a CT scan. Unfortunately, overtesting is a national problem and it's the few doctors who practice overtesting make everyone else look bad.
Beware if you see the following signs and symptoms of an urgent care company:
This is a national problem, and it is almost definitely happening in your town. Nobody is going to risk litigation by naming a company that’s doing this in your town, but you can certainly tell your friends and relatives about this, so that it’ll become a ‘public secret’. Just like we all know what place has the best Chinese food, or where you can find the best frozen yogurt, we can also help one another get good healthcare.
So please, use caution when seeking medical care for an acute illness or injury, and keep your wits about you.